What is your average percent reimbursement rate?

[thebalmofhurtminds]

For those of you who take insurance, of course. Just curious.

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[WisNeuro]

Can you clarify? Generally, there is a contracted amount that they will pay for certain services.

 

[LadyHalcyon]

Do you mean what percentage of billed services, on average, do clinicians collect?

 

[thebalmofhurtminds]

Do you mean what percentage of billed services, on average, do clinicians collect?

Yes, that's what I mean! Sorry the wording was confusing.

 

[PsyDr]

Never had a problem getting paid from non CMS places. But I read all of the provider handbooks, and am willing to play the game more than almost anyone I know.

 

[thebalmofhurtminds]

Never had a problem getting paid from non CMS places. But I read all of the provider handbooks, and am willing to play the game more than almost anyone I know.

I am unfortunately not able to negotiate as I am part of a larger system. But I was wondering what it tends to look like, because I'm seeing averages across healthcare as 30-40%, but wanted to see more specifically in MH.

 

[LadyHalcyon]

When I was billing insurance I collected almost everything I billed, apart from a few exceptions

 

[AcronymAllergy]

I am unfortunately not able to negotiate as I am part of a larger system. But I was wondering what it tends to look like, because I'm seeing averages across healthcare as 30-40%, but wanted to see more specifically in MH.

As in 30-40% collected or not collected?

Most folks I know in PP (admittedly small N) collect on the vast majority of what they bill. If I had to guess, maybe 90+%?

 

[PsyDr]

I am unfortunately not able to negotiate as I am part of a larger system. But I was wondering what it tends to look like, because I'm seeing averages across healthcare as 30-40%, but wanted to see more specifically in MH.

You don't have to negotiate. You can and should read the insurance company's "provider handbook". Those are the rules that will tell you how many units of testing are allowed, which diagnoses are accepted for a service, what requirements are present for something, how to chart, etc.

If you don't know the rules, you stand about a 30-40% chance of getting it right. You stand a much better chance if you know the rules, and only do work you're going to be paid for.

 

[thebalmofhurtminds]

As in 30-40% collected or not collected?

Most folks I know in PP (admittedly small N) collect on the vast majority of what they bill. If I had to guess, maybe 90+%?

30-40% collected out of the amount billed. I'm in a hospital system though. I'm told this is very normal and I'm a bit confused.

 

[thebalmofhurtminds]

You don't have to negotiate. You can and should read the insurance company's "provider handbook". Those are the rules that will tell you how many units of testing are allowed, which diagnoses are accepted for a service, what requirements are present for something, how to chart, etc.

If you don't know the rules, you stand about a 30-40% chance of getting it right. You stand a much better chance if you know the rules, and only do work you're going to be paid for.

I think we're talking about different things. I've certainly read my provider's handbook and I am not having issues with rejected reimbursements or doing work I'm not getting paid for in that sense. I'm told in my department that across insurances, we generally receive 30-40% of the amount we bill and as you can see, I'm confused about how that is. I'm told that's just the way it is and I'm doing it right on my end. The hospital decides the contracts with insurance companies and I don't appear to have access to this.

I'm first year out of postdoc, so as you can see, trying to learn some of these things on the go.

 

[PsyDr]

I think we're talking about different things. I've certainly read my provider's handbook and I am not having issues with rejected reimbursements or doing work I'm not getting paid for in that sense. I'm told in my department that across insurances, we generally receive 30-40% of the amount we bill and as you can see, I'm confused about how that is. I'm told that's just the way it is and I'm doing it right on my end. The hospital decides the contracts with insurance companies and I don't appear to have access to this.

I'm first year out of postdoc, so as you can see, trying to learn some of these things on the go.

That’s sounds like the ratio of hourly rate/what insurance pays. When you submit a bill to insurance, you are required to say “I charge $/hr”. Insurance gets that bill, looks at the CPT codes, glances at your hourly rate. says “that’s cute”, and then pays you their rate for that CPT code.

I believe that your employer is talking about a ratio of: the made up hourly rate/ what the insurance rate is.

That’s sort of bad management. They are telling you that to get you to work harder, and claiming some nonsense unearned revenue for investors. You can literally tell insurance you cost $1MM/hr. Not getting that

 

[calimich]

If I’m understanding the question correctly, I’d estimate my overall reimbursement rate is just below 74%. For a 90834 insurance pays 73% of my full fee. The percentage goes up a bit for 90791 & 90837 and down a bit for 90847. However 90834 is probably 75% of what I bill, and I collect just about all of what is owed. I can only think of two occasions, both during my first 6 months of private practice, where I was unable to collect payment for intake appointments due to my mistakes. Glad to say I haven’t repeated those mistakes.

 

[PsyDr]

 

[AcronymAllergy]

30-40% collected out of the amount billed. I'm in a hospital system though. I'm told this is very normal and I'm a bit confused.

Ahh, as PsyDr and you discussed above, that makes sense; I was misunderstanding your question.

 

[beginner2011]

If I’m understanding the question correctly, I’d estimate my overall reimbursement rate is just below 74%. For a 90834 insurance pays 73% of my full fee. The percentage goes up a bit for 90791 & 90837 and down a bit for 90847. However 90834 is probably 75% of what I bill, and I collect just about all of what is owed. I can only think of two occasions, both during my first 6 months of private practice, where I was unable to collect payment for intake appointments due to my mistakes. Glad to say I haven’t repeated those mistakes.

I'm a bit confused. When you say you collected all of what is owed, do you mean you collected 100% of your billable fee? 75% from the insurance reimbursement...where does the other 25% come from?

Or are you saying you collected on "all of what is owed" as in you collected for each session?

For example, say your fee is $200 per 90834 and insurance pays $150 per 90834. Say you provided 100 sessions last year. You collected on "all of what is owed" by billing insurance for 100 instances of 90834, and received = $150 * 100 = $15,000? Thus not receiving approximately $5k ($50 * 100 = $5,000) less than you would have billed for as an out-of-network provider? Or are you saying that you collected the $15,000 from insurance and the other $5,000 from some other source?

 

[Sanman]

I'm a bit confused. When you say you collected all of what is owed, do you mean you collected 100% of your billable fee? 75% from the insurance reimbursement...where does the other 25% come from?

Or are you saying you collected on "all of what is owed" as in you collected for each session?

For example, say your fee is $200 per 90834 and insurance pays $150 per 90834. Say you provided 100 sessions last year. You collected on "all of what is owed" by billing insurance for 100 instances of 90834, and received = $150 * 100 = $15,000? Thus not receiving approximately $5k ($50 * 100 = $5,000) less than you would have billed for as an out-of-network provider? Or are you saying that you collected the $15,000 from insurance and the other $5,000 from some other source?

Not sure, but I think @calimich means insurance reimburses at ~74% of stated fees and have been paid in all instances but two where insurance rejected the claim all together for mistakes.

 

[calimich]

Not sure, but I think @calimich means insurance reimburses at ~74% of stated fees and have been paid in all instances but two where insurance rejected the claim all together for mistakes.

Yss this is what I meant. I’m about 80-20 insurance-full fee and have collected 100% of those session

 

[SCallergydoc]

The question makes no sense. If the insurer will pay you $200 for a service and you bill $1000 for it, your collection rate will be 20%. If you bill $200 for it, your collection rate will be 100%. If you bill $100 for it, you're stupid.

 

[foreverbull]

I'm a bit confused. When you say you collected all of what is owed, do you mean you collected 100% of your billable fee? 75% from the insurance reimbursement...where does the other 25% come from?

Or are you saying you collected on "all of what is owed" as in you collected for each session?

For example, say your fee is $200 per 90834 and insurance pays $150 per 90834. Say you provided 100 sessions last year. You collected on "all of what is owed" by billing insurance for 100 instances of 90834, and received = $150 * 100 = $15,000? Thus not receiving approximately $5k ($50 * 100 = $5,000) less than you would have billed for as an out-of-network provider? Or are you saying that you collected the $15,000 from insurance and the other $5,000 from some other source?

There seems to be some confusion about how insurance works, perhaps? If your insurance company hears that your fee is $200 and then says they’ll only reimburse you $150 total, that will already include the client’s co-pay requirement (correct me if I’m wrong, folks, since I don’t take insurance).

You can’t get the last $50 from the client or else it’s considered insurance fraud because you can’t make your client pay over their stated copay if they have one or make them pay one when their sessions should be fully covered.

If you collect all of what is owed via insurance, it will still be less than what you would have collected at full fee, which would have been 100% of your rate. Insurance will only pay a percentage of that, so if you collect all that is due from the insurance company, it’ll be x percent out of 100% of your cash fee. The rest is basically lost income since you took a pay cut to work with insurance panels.

The upside is that you can quickly fill your schedule as a new practitioner and reach folks who can’t afford to pay out of pocket, so there are trade-offs.

 

[PsySeeker]

Your “cash rate” or standard fee per service is supposed to be a set a rate that you always charge for the CPT code no matter who the payer. When you agree to be part of a panel you agree to discount said rate for members of that payer. My understanding is that you are allowed to discount your rate for other panels as well, but not for individuals. You charge all the panels your rate, they apply whatever their contracted discount is.

For most, their cash/charged rate will be higher than their highest panels discounted rate, limited by how much they actually intend to charge individuals, bearing in mind that sliding scales and discounts for individuals are typically a violation of your contracts with your payers, and perhaps a serious one (they may consider it insurance fraud). I do believe arrangements for hardship are at least sometimes permissible, but I’m not sure, it may vary by payer.

I have seen that hospitals and pharmacies often charge completely preposterous cash prices that have no resemblance whatsoever to what they get paid (e.g. routinely charging 45k for a biologic drug and its administration and accepting a payer rate of 4K). I don’t understand the motivation behind this practice, but I’m sure there’s a reason.

 

[singasongofjoy]

I'm part of a psychiatry department in an AMC. I largely see folks with Medicaid, Reimbursement is about 30% of the charge. I think the other insurances pay on average maybe about 60%? but I'm on salary and the way the bonus/reward system works in our location is frankly not set up to be easy for a psychologist to get much meaningful so I only pay as much attention as I need to determine if something gets denied or looks atypical from month to month so who knows, maybe I'm missing something. But the whole system feels designed to bankrupt people without health insurance (unless they qualify for the hospital's charity care program) since we are required to charge the same per unit regardless and I'm assuming that's the same for physical medicine which is considerably more expensive. It makes me feel nauseous to think about how easy it is for someone without health insurance to get slapped with a bill that is so much higher than what my heath insurance would pay for the same service. Like is the system such that places try to make up the financial differences by just charging more, knowing that insurance companies won't change what they reimburse but there will be some folks who end up paying out of pocket? Thank god for ACA insurance as an option for some as otherwise I can imagine one of my best friends- who makes more money than I do in his two-person specialty sign business- would have been bankrupted by a gallbladder.